Teens who experience physical or psychological violence in their adolescent dating relationships have a significantly greater risk of suffering abuse in their future adult romantic relationships. A new study, led by University of Calgary, Faculty of Social Work researcher Deinera Exner-Cortens, PhD, has isolated dating violence as a strong predictor that someone will suffer future abuse, even when victimized individuals were compared to others with similar backgrounds but who did not experience dating violence.

Exner-Cortens completed this research as a doctoral student at Cornell, working with John Eckenrode (BCTR associate director and professor of human development), who is also a co-author on the article.

Domestic violence takes a huge toll on the health and well-being of victims and families. Studies have shown that intimate partner violence against women has an estimated societal cost of $5.8 billion. In this light, Exner-Cortens says her study is a wake-up call that adolescent dating violence needs to be taken more seriously.

“When I talk to adolescents, they may not recognize that what they’re experiencing is dating violence,” says Exner-Cortens. “For a lot of them, it's their very first encounter in a romantic setting, so they may not know that it's not healthy. So, from a primary prevention – or stopping it before it starts – standpoint, we want to be communicating healthy relationships messages to adolescents. That you have a right to be safe in your relationship, and if a partner ever makes you feel unsafe or hurts you, that's not okay, and you have a right to leave, and to seek help.”

Exner-Cortens’ study, recently published in the Journal of Adolescent Health, is the first to demonstrate, in a U.S. national sample, that adolescent dating violence is uniquely implicated in a cycle of violence from adolescence to adulthood, even when comparing teens who were matched on key risk factors at the socio-demographic, individual, family, peer, school and community levels.

“For a long time adolescent romantic relationships weren’t a focus in research because people thought that they didn’t really matter for well-being,” explains Exner-Cortens. “This study strongly demonstrates that violence first experienced in adolescent relationships may become chronic, and that adolescent dating violence is an important risk factor for adult partner violence.”

Exner-Cortens and colleagues analyzed a sample of 2,161 American male and female heterosexual youth from the National Longitudinal Study of Adolescent to Adult Health. Participants were first interviewed about their dating experiences when they were ages 12-18, and then again five, and 12 years later. To measure dating violence, participants were asked if a partner had ever used insults, name-calling or disrespect in front of others; sworn at them; threatened them with violence; pushed or shoved them; or thrown objects that could hurt. Over a one-year period, about 19 per cent of teen respondents reported dating violence.

Five years after they were first victimized, female victims of adolescent dating violence had almost 1.5 times greater risk for experiencing physical adult intimate partner violence, and male victims had almost twice the risk for experiencing adult intimate partner violence. Individuals who reported intimate partner violence five years after dating violence victimization were also more likely to report intimate partner violence victimization during the twelve-year follow-up. These findings were all in comparison to a group who did not experience dating violence, but who were otherwise very similar in terms of risk history to dating violence victims. Variables used to create this well-matched comparison group included known predictors of adult intimate partner violence, such as child maltreatment, substance use and mental health.

“This is the first study to show that even when we get rid of many other confounding factors, dating violence still emerges as a predictor,” says Exner-Cortens. “Something is happening in those relationships over and above other things that would predict risk. Dating violence appears to set off some sort of cycle in terms of interpersonal violence.”

Exner-Cortens is calling for improved screening for adolescent dating violence in health-care settings, as well as the need for intervention programs for teens who have experienced abuse in their dating relationships. Programs that prevent adolescent dating violence before it starts are also key to intimate partner violence prevention.

Study co-authors are John Eckenrode (Cornell University), John Bunge (Cornell University) and Emily Rothman (Boston University). The research was supported by funding from the Canadian Institutes of Health Research.

This talk is open to all. Lunch will be served. Metered parking is available in the Plantations lot across the road from Beebe Hall.

Despite the large number of evidence-based programs targeting key public health problems, the sustainable translation of these programs into practice remains elusive. In her talk, Deinera will report on practitioner feedback related to bringing the Fourth R, a curriculum-based program focused on promoting healthy relationships among adolescents, to scale in six Canadian provinces and territories. Twenty-one practitioners (71% female) who were involved in the national Fourth R scale-up over the past decade participated in the study. Quantitative survey and qualitative interview data were collected, focusing on barriers to and attributes of successful program scale-up. Interview data were analyzed using qualitative descriptive methodology. On average, participants had been involved with the Fourth R for seven years, and most were affiliated with a school board. Three broad themes related to successful program scale-up emerged from the survey and interview data: 1) the importance of program characteristics (e.g., ease of use); the importance of the system (e.g., ministry of education endorsement/recognition); and the importance of the strategy (e.g., framing implementation around existing legislation and provincial priorities). While implementation fidelity was discussed by a number of participants as important to successful scale-up, only 50% reported that their jurisdiction had an existing process to monitor fidelity. The findings from this study highlight key factors that impacted the national scale-up of a school-based healthy relationships program in Canada, and can be used to inform future dissemination of curriculum-based health promotion programs.

Deinera Exner-Cortens, Ph.D., MPH, is a postdoctoral fellow at the CAMH Centre for Prevention Science in London, ON. She received her Ph.D. in Developmental Psychology from Cornell University in 2013. Deinera's research focuses on understanding interpersonal violence in intimate relationships. Past and current projects in this area include media framing of domestic homicides in Botswana, intimate partner violence in the lives of Canadian Aboriginal women, prevalence of sexual violence in gay, lesbian and bisexual populations in the United States, longitudinal outcomes of teen dating violence victimization and the evaluation of a campus-based sexual violence prevention program. In her doctoral dissertation, Deinera explored the association of teen dating violence with future re-victimization by adult intimate partners, as well as the measurement of psychological aggression. Her current work focuses on evaluating healthy relationships programming for adolescents.

Jennifer Tiffany's paper, Context matters: Setting-level influences on active program participation and HIV risk reduction among urban youth (co-authored by Deinera Exner-Cortens, Mary Maley, Sara Birnel Henderson, and John Eckenrode) was part of a panel on Social-Ecological Supports for Reproductive Health Among Diverse Populations of Adolescents and Young Adults sponsored by APHA's Maternal and Child Health section.

Mary Maley's paper, 'It's just a piece of paper': Teen perceptions of orders of protection for dating violence was part of a panel on Issues in Family Violence: Policy, Prevention, and Intervention, also sponsored by the Maternal and Child Health section. It was co-authored by Jane Powers, Deinera Exner-Cortens, Sara Birnel Henderson, and Jennifer Tiffany.

Work from two BCTR projects were also presented: Evaluating the implementation of evidence-based programs that promote adolescent sexual health: Lessons learned from New York State (Jane Powers, Christine Heib, Amanda Purington, and Mary Maley) and the poster Partnering with homeless youth to study the scope and nature of youth homelessness (Jane Powers, Christine Heib, and Amanda Purington).

The theme of this year's annual meeting was "Think global, act local: Best practices around the world" and included a rollout of the APHA's media campaign "We can do better" (video) aimed at building health equity as well as confronting and eliminating health disparities. This was the 141st annual meeting of the APHA, whose mission is to "improve the health of the public and achieve equity in health status" and whose new tag line is "For science. For action. For health."

An April 1 article in the Boston Globe outlines the need for better conversations with teens about dating violence. As the author points out, most parents are knowledgeable about and talk to their children about drinking, drugs, and sex, but dating violence is not yet on the list of essential conversations.

A teenager’s first romantic relationship plays a critical role in helping an adolescent develop a sense of who he or she is — personally and sexually…If a teen’s first intimate relationship is abusive, it may skew what his or her view of what a healthy relationship looks like.

PerformWellwas launched by the Urban Institute, Child Trends, and Social Solutions as an on-line source of measurement tools that “human services professionals can use to manage their programs’ day-to-day performance. Information in PerformWell leverages research-based findings that have been synthesized and simplified by experts in the field. [This will help] human services practitioners deliver more effective social programs.” In addition to enabling easy access to assessment tools, the site guides practitioners as they identify appropriate outcomes to measure and as they use data to improve program delivery.

The 20-item TEPPS assesses participation and engagement in programs serving adolescents and includes subscales measuring Personal Development, Voice/Influence, Safety/Support and Community Engagement.

Doctoral student Deinera Exner-Cortens and co-authors BCTR director John Eckenrode and Emily Rothman (Boston University School of Public Health) recently published a paper demonstrating that the consequences of teen dating violence are multiple adverse health affects in later life. Longitudinal Associations Between Teen Dating Violence Victimization and Adverse Health Outcomes was published online on December 10, 2012 by the journal Pediatrics.

Teens are experiencing their first romantic relationships, so it could be that aggressive relationships are skewing their view of what's normal and healthy and putting them on a trajectory for future victimization. In this regard, we found evidence that teen relationships can matter a great deal over the long run.

This is the first longitudinal study of a nationally representative sample to show connections between teen dating violence and later negative health outcomes in young adults.

The paper, co-authored with John Eckenrode, Deinera Exner-Cortens, and Sara Birnel-Henderson and titled Active Program Participation and HIV Risk Reduction among Urban Youth, highlighted the new measure of youth program participation generated by the study; significant positive associations among program participation, social connectedness, and HIV risk reduction scores; possible impacts of average setting-level participation scores on individual youth risk reduction practices; and connections between longer program involvement increased impact of youth participation on risk reduction practices.

Other papers on the panel addressed community development programs and anti-retroviral therapy for youth in Zimbabwe, national adolescent HIV prevention strategies in 20 countries with high HIV prevalence rates, and strategies to make programs focused on pregnancy prevention and HIV risk reduction work in tandem.

The Complementary Strengths Research Project is supported in part by award #R21NR009764 from the NIH/National Institute of Nursing Research and by USDA grant #NYC-323442-0219950. The content of the report is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Nursing Research, the National Institutes of Health, or the USDA.

Translational research includes developing and validating new measures that can be used during efficacy and effectiveness trials and in implementation research. It is ideal if these measures can also work as evaluation tools in real world programs. The Complementary Strengths Research Partnership worked with New York City after-school (out of school time) programs to develop and validate a new scale that community-based programs can easily use to assess the quality of youth participation. Complementary Strengths can also use the scale to test the efficacy of the setting-based intervention it is developing.

A review of the research literature demonstrated the need for a new way to measure youth participation. Much assessment of program participation looks only at how much time youth spend involved in program activities or at how many different types of activities they join, rather than at the quality of their experiences. Findings from the Complementary Strengths Study and other studies suggest the important role experiences of high-quality program participation have on young people’s healthy development, but the field lacked a validated short scale for measuring participation quality as experienced by youth. Youth participants, program staff, and researchers worked together to develop and fine-tune items for use in the new scale. Work to develop the measure included a number of phases - a pilot study involving 98 youth, a longitudinal exploratory study involving 329 youth, and use of the new tool in a program evaluation project now underway.

Research team members Jennifer Tiffany, John Eckenrode, and Deinera Exner-Cortens recently published an article spelling out how the new 20-item scale was developed. The scale is now available for programs and researchers to use in their own evaluations, program improvement efforts, and studies of youth development practices in community settings.

The overall scale encompasses four subscales measuring Personal Development (7 items), Voice/Influence (4 items), Safety/Support (4 items), and Community Engagement (5 items). In addition to measuring these key elements of youth engagement in programs, scores on the scale are significantly correlated with measures of social connectedness and sexual health promotion. A technical description of the measure is available here.

The Complementary Strengths Research Project is supported in part by award #R21NR009764 from the NIH/National Institute of Nursing Research and by USDA grant #NYC-323442-0219950. The content of this report is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Nursing Research, the National Institutes of Health, or the USDA.

Stephen Hamilton organized and chaired two sessions: a paper symposium, Social Inventions in Different Countries to Improve the Transition to Adulthood with Mary Agnes Hamilton; Constance Flanagan; and Ana Lazzaretti & Silvia Koller; and a roundtable, Linking Research with the Practice of Youth Development with Mary Agnes Hamilton; Reed Larson; David DuBois; Nicole Yohalem.

Janis Whitlock moderated the roundtable, Ethical Considerations in Engaging Vulnerable Populations in Self-Harm Research. Janis also chaired the symposium, Adolescent Self-Harm across Culture and Context: Similarities and Differences in Risk and Protection and served as co-chair of the SRA sub-committee on Media and Communications.

Deinera Exner-Cortens co-authored (with Jennifer Tiffany and John Eckenrode) and presented the poster, Longitudinal Associations Between Sexual Risk Reduction and Program Participation in a Sample of Urban Adolescents (view poster). Deinera also presented the poster Teen Dating Violence and Subsequent Health Outcomes in a National Sample of Youth, which was co-authored with John Eckenrode and Emily Rothman.

Additionally, with HD graduate student Rachel Sumner, Stephen Hamilton co-authored a poster, Are School-Related Jobs Better? (view poster); and Jennifer Tiffany co-authored the poster Access and Barriers to Resources that Support Parents as Sex Educators: Parent Focus Group Data on Family, Race/Ethnicity, and the Community with graduate student Nicole Ja.

"Why Would You Wanna Be in a Relationship Like That When You Could Be in a Healthy One?": A Qualitative Investigation of Adolescents’ Beliefs about Dating Violence and Aggression
Deinera Exner-Cortens, graduate student, Human Development

In order to investigate the importance of contexts in aggressive interactions, this study examined adolescents’ thoughts on violence and aggression in dating relationships. High school students in Ithaca, NY in grades 9-12 (n=21) participated in a 40-minute semi-structured interview, and were asked for their thoughts on dating, dating violence and psychological aggression in dating relationships. Five main themes emerged from this analysis, as well as a list of 13 actions that the participants felt constituted psychological aggression. Actions listed by males and females in the sample differed in both frequency and perceived severity. In her talk, Deinera will discuss the findings from this study that support efforts to include assessments of context in studies of dating violence, and the application of this work to future research.

Deinera Exner-Cortens is a third year doctoral candidate in Human Development. She holds an MPH in Social and Behavioral Science from Boston University (2009), and a BSc in Cellular, Molecular and Microbial Biology from the University of Calgary (2007). Deinera's research focuses on understanding interpersonal violence in intimate relationships. Past and current projects in this area include media framing of domestic homicides in Botswana, intimate partner violence in the lives of Canadian Aboriginal women, prevalence of sexual violence in gay, lesbian and bisexual populations in the United States, longitudinal outcomes of teen dating violence victimization and the evaluation of a campus-based sexual violence prevention program. Currently, Deinera is working on her doctoral dissertation, which focuses on teen dating violence. The goal of this project is to provide practitioners with an improved understanding of how psychological aggression is used in teen dating relationships, as well as to highlight how depression and substance use may contribute to risk for re-victimization. Upon completion of her doctoral degree, Deinera plans to return to Canada, where she hopes to work in the public sector as an applied researcher.

Lunch will be served. This talk is open to all. Metered parking is available across Plantations Rd. in The Plantations lot.